Measuring access to food in developing
countries: the case of Latin America

Food insecurity is widespread across the globe, and the
international community has placed the elimination of famine and hunger on its
agenda. Measuring and quantifying food insecurity is a crucial component of
making progress towards the improvement of food security. Many estimates of food
insecurity depend on statistics that are resource-intensive to obtain. This
paper presents one possible approach towards measuring the share of the
population that might be affected by food insecurity and to what extent. This
approach relies on secondary data sources and thus avoids the high cost of
primary data collection. A food security threshold can be calculated as the sum
of the cost of a food basket and the cost of other basic necessities, and then
compared with available income. The approach is illustrated for nine Latin
American countries, all of which have segments of their populations that are
considered vulnerable.

From the estimation of the gap between per capita income and
the cost of a basket of food as well as other basic necessities, it is possible
to determine the number of people who lack the purchasing power to satisfy their
basic needs.

In this study, retail prices for several food items for nine
lower-income countries in Latin America are used to calculate the cost of two
kinds of food baskets: a representative healthy food basket and a
low-cost healthy food basket. The representative healthy
food basket fulfills basic nutritional guidelines while reflecting the range of
foods typically eaten in each country. The low-cost healthy food
basket is constructed in a way to satisfy nutritional guidelines at the lowest
possible cost.

After the cost of the two food baskets are calculated,
assumptions about the cost of other basic necessities are made. The sum of the
cost of the food basket and the cost of other necessities can be considered as a
food security threshold. The gap between actual incomes and the food
security threshold determines the depth of food insecurity.

To estimate the purchase price of the food basket, we
distributed 2 170 kilocalories - derived from region-specific caloric standards
recommended by FAO - among specific food and nutrient groups, according to
several criteria. These criteria included typical country food consumption
patterns, FAO/World Health Organization nutritional guidelines for developing
countries and standards from various US government agencies. The diets are
largely plant-based, and the goal was to have roughly 65 percent of daily
kilocalories coming from carbohydrates, 20 percent from fat and 15 percent from
protein. Respecting the diets of the countries, one or more commodities were
selected to represent each nutrient group. The healthy
representative food basket typically included between three and six food
items in the carbohydrate group, while the low-cost food basket only
included one or two of the least costly food items. Cereals, roots and tubers,
bananas and plantains were the food items selected to represent the carbohydrate
group; milk, meat or pulses were chosen to represent protein; and vegetable oils
represented fat. No attempt was made to analyse the adequacy of micro-nutrients,
such as iron or vitamin A, in the diet. However, low-calorie intake is typically
closely related to low levels of consumption of a wide range of essential
vitamins and minerals, and a more diversified diet is more likely to prevent
shortages of micronutrients.

The ratio of available income to food security threshold is a
meaningful indicator of food security. A ratio of greater than one indicates
that income levels exceed the threshold, and therefore people in this quintile
are not vulnerable to food insecurity. Any number less than one alerts us to the
danger of food insecurity in this income quintile: the lower the number, the
more severe the problem.

To examine the implications of skewed income distribution on
food security, we allocated national income across five income groups within
each country according to income distribution data from the World Bank. We then
compared these per capita income levels of the five quintiles to the food
security threshold. On average, incomes in the lowest income group are roughly
equal to the food security threshold for the low-cost basket.

Conversely, incomes for the highest income group were about 16
times higher than the threshold level. With respect to individual countries, the
income level of all five quintiles in Bolivia, Columbia, the Dominican Republic,
Ecuador, El Salvador and Peru exceeded the threshold level to purchase food and
basic necessities. This means that less than 20 percent of the population in
these five countries are vulnerable to food insecurity. In Guatemala, roughly 20
percent of the population had insufficient purchasing power to afford the
necessities. In Honduras and Nicaragua, by far the poorest of the nine
countries, about 40 percent of the people fell into this category.

In addition to the low-cost food basket, we also made an
assessment for a representative healthy food basket, whose costs are
obviously higher. Consistent with this is the finding that incomes did not go as
far in meeting the food security threshold for this type of food basket. In
1999, the lowest income group in all countries fell short of meeting the food
security threshold using the representative healthy food basket
approach. This means that at least 20 percent of the population of these nine
countries could not afford the healthy food basket and other necessities.
Incomes in Peru were the closest to meeting the target level, as the per capita
income in the lowest income group was 87 percent of the threshold level. In
Bolivia, 40 percent of the population had incomes below the food security
threshold. Reflecting the vulnerability of the poorest people in these
countries, incomes in this lowest quintile in Honduras and Nicaragua were only
27 percent of the threshold level. In fact, the three lowest income quintiles in
these two countries fell short of meeting the threshold level, meaning that
roughly 60 percent of the population fell short of the threshold
level.

Prediction of childhood anthropometric
parameters based on a poverty index: an empirical statistical method using
demographic and health survey data

Malnutrition is thought to be indirectly responsible for half
of all child mortality in poor countries (WHO, 2002). As part of an analysis of
the global burden of disease attributable to poverty (Blakely et al., 2002), we
analysed the relationship between poverty and anthropometric parameters using
data from Demographic and Health Surveys (DHS) (Macro International, 2002). We
estimated that children living on less than US$1 per day were two to three times
more likely to be malnourished than those living on over US$2 per day. The focus
of this paper is on the statistical association of poverty indices and
malnutrition in eight regions defined by WHO.

Method

Four rounds of DHS have been conducted in which several
thousand households were sampled at intervals in poor countries across Asia,
Africa, the Near East, Latin America and the former Soviet Union. These data
have been used to generate indices that can be used as a proxy for income
(Filmer and Pritchett, 1988). Unlike those analyses, which were carried out at
the level of individual countries, we combined household data for 42 countries,
taking the most recent survey if the country had been surveyed more than once
during 1986-2000. Data from the first round of surveys were recoded to ensure
comparability with the subsequent three rounds. We used factor analysis to
create a poverty index based on three categorical variables: housing
construction material (usually floor material), educational status and
availability of electricity. If these variables were missing for a particular
country, a substitute variable was used as follows: wall material was
substituted for floor material for Pakistan; number of rooms was substituted for
floor material in India; possession of a radio was substituted for electricity
supply in Burundi, Dominican Republic, Liberia and Tunisia. The variables were
recoded with numeric values as follows: electricity: 0 = no, 1 = yes; highest
education level: 0 = none, 1 = primary, 2 = secondary, 3 = higher; floor type: 1
= natural, 2 = rudimentary, 3 = finished.

Data were available for age, height and body weight for 160
000 children under five years of age. Within each of the 24 discrete values of
the poverty index and for eight study regions as defined by WHO, we calculated
average height-for-age and weight-forage Z-scores. Regression models were used
to explore the relationship between these parameters and poverty.

Results

The first factor had an Eigenvalue of 0.98. The factor
coefficients were 0.277 for educational status, 0.373 for electricity and 0.319
for construction material. There were 24 discrete values of the poverty index,
ranging from -0.85 (poorest) to 1.55 (richest).

In weighted linear regression models, childhood malnutrition
within each region was well predicted by the poverty index. In a model
containing the poverty index plus dummy variables for each region, the
height-for-age Z-score decreased by 0.45 (95 percent confidence interval:
0.42-0.50) and the weight-for-age Z-score by 0.39 (0.35-0.42) for a one unit
increase in poverty index. Inclusion of interaction terms between WHO regions
and the poverty index increased the model fit only slightly (the height-for-age
model R2 increased from 0.87 to 0.89, and the weight-for-age model
R2 increased from 0.92 to 0.94). The coefficients for these
interaction terms were mostly not statistically significant.

Discussion

We have demonstrated a strong statistical relationship between
an index of poverty and anthropometric indicators. This is not an unexpected
finding; for example, short stature has previously been shown to be related to
poverty rather than to genetic factors (Bustos et al., 2001). The size of the
effect demonstrated here is remarkably consistent between WHO regions and quite
substantial in public health terms. This finding supports a causal association
between poverty and malnutrition. We propose that the distribution of
undernutrition by poverty can be predicted based simply on knowledge of the
overall prevalence of malnutrition and data on the distribution of poverty.
These findings could contribute to assessment and improvement of the nutritional
status of vulnerable populations. For example, our poverty index can be
calculated for many countries in which direct measurements of anthropometry have
not been made.

Improving food security, nutrition and health status of
indigenous peoples who reside in their homelands in rural areas requires a
thorough understanding of the local environment and traditional food system
known and used by the culture. Indigenous peoples often use unique food species
and methods of processing, and the traditional knowledge required is often as
endangered as the species themselves. Further, indigenous peoples can be the
economically poorest and most disenfranchised part of many societies for whom
attention to health status is a public health necessity, especially when rapid
dietary change is in effect or anticipated.

This project, still in progress, has the short-term goal of
defining a method for documenting indigenous peoples traditional food
resources and the long-term goal of using these local resources for programme
planning to ensure adequate diets and good nutritional status. Case studies to
test the suitability of the method in Asia are represented by the co-authors and
their team members in the following areas:

India: with Dalit
women farmers in Andhra Pradesh with guidance from Salome Yesudas, Deccan
Development Society;

Thailand: with the
Karen People of Kan-chanaburi Province with guidance from Dr. Suttlak Smitasiri
and team, Mahidol University, Salaya;

Bangladesh: with the
Mogh Tribals and Nayakrishi farmers of Coxs Bazaar District with guidance
from Dr. Salek Ahmed, Policy Research for Development Alternative (UBINIG),
Dhaka;

China: with the Miao
National Minority of Sichuan Province with guidance from Dr. Li Dan of the
Chinese Center for Disease Control and Prevention, Beijing, and Dr. Zhai
Fengying of the Institute of Nutrition and Food Hygiene, Chinese Academy of
Preventive Medicine, Beijing.

A workshop held in March 2001, in which the case study leaders
participated, developed the draft protocol that includes the participation of
six interdisciplinary specialists in each case study. These are: (1) the
indigenous local leadership, (2) herbarium and zoological identification
specialist, (3) food culture specialist, (4) food analysis laboratory and data
specialist, (5) food and dietary database specialist and (6) local agricultural
and/or environment protection specialist. The protocol includes five basic steps
of collecting qualitative and quantitative data to document the food system of
indigenous people and to identify local foods suitable for promotion to improve
health. The five steps are: (1) consulting with experts and gathering background
data, (2) identifying traditional food lists, (3) seeking the scientific
parameters of traditional food, (4) understanding the cultural contexts and
dietary evaluation for food use and (5) planning interventions to improve
nutrition using local traditional food, if warranted. Focus is being made on
macronutrients (protein, carbohydrate, fat), energy and five micronu-trients
(vitamin A, iron, zinc, folic acid and vitamin C) in nutrition of women and
young children.

As of July 2002, the case studies are still gathering data and
testing the method in the respective regions. At this point, we know that there
are 90-276 food species documented in the five areas. Table 1 shows the number
of species, the number still to be identified and the number requiring analysis
for nutrient content. Folic acid and zinc are the most frequently missing
nutrient data in the world literature for these species.

TABLE 1. OVERVIEW OF TRADITIONAL FOOD SPECIES IN FIVE
CASE STUDIES

Case studies

Number of species

To be identified

To be analysed

Karen

129

15

51

Dalit

276

39

40

Mogh/Nayakrishi

155

11

47

Miao

90

4

7

Bhil

97

17

34

Nutritional status of women and children in the five areas
varies and has yet to be completely assessed and reported. Similarly, the
feasibility of using traditional food for improving nutritional status and
strategies for doing so are still being determined.

All case studies report that the methods applied up to this
point in time have been successful. However, there are several barriers to good
data collection evidenced in the case studies. For example, funding delays
result in project delays and can interfere with good interdisciplinary
collaboration. Participatory techniques and research agreements or informed
consent are usually verbal, and the importance of complete and thorough
consultation in advance of project initiation is considered to be essential.
There are an unexpectedly high number of food items with missing data on
scientific identification or analytical data for nutrient contents. Another
important methodological issue relates to the requirement for simultaneous work
in multiple languages for adequate data collection and interpretation.
Regularly, translation is required from the local language to the provincial
language, then to the national language and finally to English for report
writing. This requirement results in additional personnel and costs. The use of
the traditional food system data for incorporation into the analysis of dietary
information requires an inexpensive, user-friendly method that can be applied at
the grass roots level for which unique local species and local language can be
inserted. For example, a successful method was developed in the Bhil case study
that used calculation by hand of dietary nutrients.

In conclusion, working with indigenous peoples food
systems requires recognition that indigenous peoples universally prefer health
promotion activities using their local food. Implementation of the method
stressed in all cases that grass roots local community work can be successful
when using interdisciplinary and participatory methods. Both qualitative and
quantitative data are needed to evaluate the potential of the local food system
for improving nutritional status. Understanding the unique local species and
varieties of food often requires new identifications, food analysis and dietary
analysis methods that are appropriate to the setting in which they are
applied.

Traditional food patterns and dietary
intake of Bhil tribes in the Dang district of Gujarat, western
India[28]

Understanding the food and dietary patterns of indigenous
populations often poses unique challenges. The tribals in India represent a good
example of indigenous populations with the vast diversity in their culture,
tradition and environment that particularly influences their food systems, food
practices and patterns and nutritional status.

A study on 187 Bhil tribal households in Western Gujarat,
western India was undertaken to understand their traditional food patterns and
dietary profiles. The study group was divided into six categories based on their
landholdings. Most of the foods in their diets included those obtained from the
jungle and local harvesting.

Ninety-seven commonly consumed foods were identified as part
of the Bhil traditional food list. Twenty-nine foods were procured from the
jungle, 26 were cultivated and 14 were hunted. The nutritive values of the
majority of the foods were calculated using the Indian food composition tables.
The nutritive values including the macro- and micronutri- ent content of 16
locally grown vegetables and fruits were not reported in the Indian food
composition tables and needed to be analysed, while other foods needed to be
identified scientifically before beginning the analysis for nutrient content.
The mineral content for calcium, iron, copper, zinc, magnesium and phosphorus of
five traditional foods - junglikhand (a type of wild tuber), mokha leaves (tough
green leaves), vasarta (a type of mushroom grown on the bamboo tree), teruna
leaves (a type of tuber leaves) and doli mahuda seeds (fruit seeds) - were
analysed at the National Institute of Nutrition in Hyderabad, India. Only two of
these traditional foods, namely, doli mahuda fruit seeds (Bassia latifolia) and
teruna leaves (Colocasia/Chlorophytum) have been scientifically identified;
identification of the other five is under way. Dried vasarta (mushroom), as it
is commonly used, has a protein content of 20 g per 100 g and can serve as an
inexpensive and potential source of protein in the Bhil diet.

Data on the community food system were gathered through key
informant household interviews, during which information was also collected on
the seasonality of use, procurement and cost of production. The community
organizers were trained by the professional dietetic study team to undertake
community-based dietary data collection. Household and individual dietary intake
data were obtained by use of the food record and 24-hour dietary recall methods.
Food frequency methods were used to collect information on the frequency of
consumption of each food item from a list of food items in reference to a
specified period during the previous month or week during the season of study. A
semiquantified questionnaire was used that incorporated questions on portion
size of each food item using household measures. Individual dietary data were
collected for 40 pregnant women, 124 lactating mothers and 15 preschool
children. The food consumption data obtained were converted to raw weights, and
the nutrient intakes were calculated manually using the Indian Nutritive Values
and Food Composition Tables of the Indian Council of Medical Research.

In general, the analysis of food consumption showed that rice
was the most commonly consumed cereal among all income groups, followed by ragi
(millet), more popular among the lower income groups. Of the traditional food
list, 18 types of meat, poultry and fish were commonly consumed because of their
easy availability, followed by 13 different types of pulses and legumes and 10
types of green leafy vegetables. Fish, an integral part of the diet, was
consumed by 27 percent of households, and animal foods (meat and poultry) were
consumed by 19 percent. Because of their easy availability from the nearby
jungle, fruits were consumed in large quantities but showed a seasonal
consumption pattern. Eight kinds of typical fruits were collected from the
jungle, while mango and papaya were grown by some of the households.

The use of traditional foods was found to vary with season.
Out of 78 traditional foods, 23 including six varieties of fish and five types
of green leafy vegetables were typically consumed during the monsoons. Sixteen
traditional foods were consumed during the summer, but very few were taken
during the winter. Mango in particular was a favourite among the families during
the summer, as well as green leafy vegetables like cowpea leaves and meat such
as deer. Typical types of wild roots and tubers were gathered from the jungle to
satisfy the food needs of households, and these were commonly eaten during the
monsoon and winter season. Twenty foods were consumed throughout the entire
year.

An analysis from the 24-hour dietary recalls showed the
inter-relationship between the top ten foods rich in carotene, iron and vitamin
C taken from the traditional food list and the consumption pattern by the
subjects. It was noted that rich sources of carotene such as drumstick and
fenugreek leaves were eaten by only 1 percent of the study group, while other
fairly good sources such as fruits and other vegetables were consumed by 3-6
percent. Among the dietary sources of iron, green leafy vegetables were consumed
by 0-2 percent of the households, while fish and crab were consumed by 3-6
percent. Among the vitamin C-rich foods, seasonal fruits had a 1-2 percent
consumption pattern, while tomatoes, a fair source of vitamin C, showed the
highest consumption of 6 percent.

Micronutrient-rich foods were consumed on average once or
twice a week by children 1-6 years of age and once to three times a week by
pregnant and lactating women. The dietary energy and protein intakes of pregnant
women and preschool children largely failed to meet the recommended daily
allowances.

Within the context of the Bhils traditional food system,
there exists a high potential to promote the usage of a variety of
micronutri-ent-rich foods in the diet. This would help to increase dietary
diversity and would serve to meet their micronutrient requirements.
Community-based, integrated nutrition interventions facilitated by social
mobilization strategies emerge as potentially promising ventures to be
undertaken.

The relevance of a spatial and
integrated analysis of underlying causes of malnutrition

The relevance of a spatial and integrated analysis to
understand the underlying causes of malnutrition was presented by Action Contre
la Faim (ACF) with a focus on a case study in an emergency context: that of the
Kailahun district in the Eastern Province of Sierra Leone.

ACF has been operational in Sierra Leone for a decade in the
ever-changing context of that country. One of the key issues during this time
has been the continued movements of population fleeing the terror of war. April
and May 2001 saw a large influx of people returning to their homes in the
district of Kailahun, either from their displacement in Sierra Leone or from
their period as refugees in the neighbouring countries of Liberia and Guinea.
Coupled with this was an influx of refugees seeking refuge from the continued
insecurity in Liberia. ACF attempted to understand more fully the humanitarian
situation of these different population groups including, as well, those who had
been residents in the area throughout the war.

Background to the project

The project had, as its base, a number of assumptions, which
were as follows:

the
increasing volume of information in increasingly complex contexts of
intervention;

the limiting aspects
of existing tools;

the increasing
importance of external communication and quality information-backed
positioning.

The project is in a phase of continued development, but when
completed, the final structure for the integrated geographic information system
(GIS) will comprise the water and sanitation database that includes water and
sanitation works, the database of the nutrition department including beneficiary
tables from the nutritional care centres, a food aid database with information
from beneficiary registers, the food security database including
food-security-specific contextual tables and market price tables and finally
contextual tables common to all domains.

Manipulation of these data and transfer into a map format
(MapInfo) allows a spatial vision of the raw data.

Information collection

The type of information collected for the project, more
specifically for this case study, falls into the following categories:

context/programme static data: collected at the village level and chiefdom
level;

context dynamic
data: collected at the village level and chiefdom level;

water and sanitation
dynamic data: collected at the household level, village level and chiefdom
level;

The original data were collected through a variety of sources
and triangulated before being entered into the database. Key informants, focus
groups and individual households contributed to the information collection,
which, where necessary, was cross-checked at the national level. This
information collection was rapid, sometimes over just a few days, owing to the
emergency context and the need for a rapid reaction. Nutrition surveys carried
out by ACF provided the nutrition rate data, while the crop and water
information was obtained through field assessments and from ongoing fieldwork
conducted by the food security and water and sanitation departments,
respectively.

The information presented in the oral contribution to the
Symposium was kept simple. In Kailahun, in the ACF chiefdoms of operation, among
much more detailed information, the following were collected and
analysed:

the
population by sectors: refugees, returnees and hosts
(residents); the agricultural
production by major crop: upland rice, swamp rice and
groundnuts; the agricultural
production per family and per crop;
the malnutrition rate; the water
supply coverage.

Analysis

Classically, this information is analysed using the
nutritional causal analysis as a framework to understand the immediate,
underlying and basic causes of malnutrition, and to make programming
recommendations as appropriate for tackling one, two or all of the causes. The
GIS system also allows ACF to exploit fully this analytical framework that is at
the base of all its assessments, through entry of the information into the
database and subsequent mapping of the integrated information collected. In the
case of Kailahun, this system allowed ACF to see clearly chiefdom differences in
production and malnutrition that related significantly to the concentration of
population sectors in that chiefdom. More precisely, the map showed that in one
chiefdom of Kailahun, there was a high proportion of returnees with limited crop
production, high numbers of people sharing the water points and relatively high
levels of both severe and moderate malnutrition, revealing that the causes of
malnutrition were not only food-related but also linked to water access, and
that returnees were more affected in that area. As mentioned earlier, this is
very much simplified; far more complex analysis can be, and is, undertaken with
this system, providing links between the information that otherwise would be
more complex to analyse.

Programme outcomes

Programming outcomes are entirely dependent on the analysis of
data collected in detailed assessments. In the case of Kailahun, the
interventions in those areas revealing the highest needs shown clearly on the
maps included:

rehabilitation of water wells,
nutritional feeding centres, and
recommendations on food aid and on seeds and tools inputs.

Further work on, and prospects for, integrated spatial
analysis in ACF

Development of the GIS database is itself dynamic, and future
tasks includes:

Work on
methodology by the technical department on standard information qualification
for systematization of the above information collection. While the databases for
water and sanitation and the nutrition information have been finalized, work is
still to be carried out on standardization of food security information, this
being very much qualitative- and context-related. To this end, an expatriate has
been appointed, combining work in the field with that in headquarters to
complete this complex but crucial step.

Training of
staff.

Development of the
integrated Access database.

Test of the defined
rapid assessment methodology and new information collection system.

Conclusion

While ACF is not the only organization operating geographic
information systems (others collecting information for early warning systems
include FIVIMS, FEWS, Global Information and Early Warning System, etc.), what
differentiates the work of ACF is that the information collection is done at the
micro (household) level or village scale and is pro-gramme-related. It is
therefore much more precise, collected often where ACF is the only actor and,
through wider assessments, can be directed to potential areas of intervention
for ACF. This tool is also a complement to information collected and analysed on
a macro scale by the global early warning systems as a result of this
specificity.

Internally, the integration of information from all the
technical departments within ACF (nutrition, food security, water and
sanitation, and medical) using this system allows not only a comparison in time
and space within an area, region or country, but also a between-country
comparison. More importantly, it gives ACF the ability to understand the
underlying causes of malnutrition and to obtain more precision in programming to
address these underlying causes. It helps to channel information collection to
those immediate factors that are useful for ACF in a programming aspect, helping
the organization to find the best way to be reactive: identifying needs and
targeting the most vulnerable populations with pertinent programme design to
address these needs in a better way and thus providing quality humanitarian
responses.

[28] Case study as part of
FAO Project on Documenting Traditional Food Systems of Indigenous Peoples in
Asia.